Provider Demographics
NPI:1770740433
Name:BROWN, STACEY C (MA, LMHC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:C
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BARKLEY CIR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4518
Mailing Address - Country:US
Mailing Address - Phone:239-275-3900
Mailing Address - Fax:239-275-3903
Practice Address - Street 1:40 BARKLEY CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4518
Practice Address - Country:US
Practice Address - Phone:239-275-3900
Practice Address - Fax:239-275-3903
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4462101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health